NOMINATION REVIEW BOARD CHAIRPERSON’S RECOMMENDATION
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OPNAVINST 1420.1B 14 DEC 09
Section 7 to Chapter 7 of Enclosure (1) 8-52 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
Applicant’s Name (Last, First, MI) Title/Rank SSN
NOMINATION REVIEW BOARD CHAIRPERSON’S RECOMMENDATION
Chairperson Name Command Street Address City State Zip Work Phone DSN FAX
Please evaluate the candidate in the following areas:
TRAITS Outstanding Excellent Good Satisfactory Unsatisfactory Leadership Potential
Professional Performance
Personal Appearance
Teamwork Technical/Rating Knowledge (if applicable)
Academic Potential
Officer Potential Motivation for Program
Overall Evaluation
This candidate does/ does not meet eligibility requirements for the program option(s) for which they are applying.
(Provide amplifying information below that would help a board in making a selection determination. Address and make recommendation if applicant requests a waiver of any program eligibility requirement. If member is applying for consideration for both a target option program and the Core Program, provide comments covering both programs.)
By my signature I certify that this candidate meets program eligibility requirements and that any waiver request(s) has been addressed in the endorsement letter. Signature Date
p. 167
OPNAVINST 1420.1B 14 DEC 09
Section 8 to Chapter 8 of Enclosure (1) 8-53 SECTION 8 GUIDANCE TO COMMANDERS AND COMMANDING OFFICERS ON SEAMAN TO ADMIRAL-21 NOMINATIONS
1. Today’s Navy must make every effort to select, train, and develop the very best and brightest candidates to meet the challenges our officer corps will face in the 21 st Century. The Seaman to Admiral-21 (STA-21) Program is a significant improvement over the enlisted commissioning programs of the past. It focuses the selection of enlisted personnel for officer accession under a single programmatic umbrella, provides increased financial support to Service members who seek to become naval officers, and simplifies application and selection processes.
2. Your role is absolutely critical to ensure only those who possess the greatest potential to become outstanding officers are offered the opportunity to earn a commission. Your personal recommendation is the single most important factor in the STA-21 selection process. Look into the candidate’s eyes and ask yourself, “Does this young man or young woman possess the character, intellect, drive, leadership potential, and devotion to become a good naval officer?” Remember that you are nominating those who will, in the future, exercise the immense responsibility of command that you enjoy today.
3. Leadership and integrity are the primary officer attributes. Although the applicant’s academic record and desire may be exemplary, they are not enough. While academic potential should play a role in your recommendation, it must not override leadership potential and other indicators of future success as a naval officer. Every STA-21 selectee should reasonably be expected to not only complete a college education, but also serve as a career naval officer.
4. Since members of the STA-21 selection board will not have first-hand knowledge of each applicant’s potential and attributes, selections are based solely on information contained in the application. During your personal interview with the applicant, you have the opportunity to reveal information about the nominee’s potential that would be very valuable to selection board deliberations. If you nominate more than one applicant, clearly differentiate the relative potential of the various candidates. There simply is no more important issue than the future leadership of the Naval Service. Your part in this process cannot be understated. The Navy is relying on you to
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OPNAVINST 1420.1B 14 DEC 09
Section 8 to Chapter 7 of Enclosure (1) 8-54 clearly communicate the nature and strength of your recommendation to help select our finest candidates.
Initial Interview: Date: Signature of Commanding Officer
Final Interview: Date: Signature of Nomination Review Board Chairperson
p. 169
OPNAVINST 1420.1B 14 DEC 09
Section 9 to Chapter 8 of Enclosure (1) 8-55 SECTION 9 STATEMENT OF UNDERSTANDING - NUCLEAR OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 170
OPNAVINST 1420.1B 14 DEC 09
Section 9 to Chapter 8 of Enclosure (1) 8-56 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (NUCLEAR OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 (STA-21) Commissioning Program as a Nuclear Power Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less (42 months for an established 5-year degree program).
b. Full time student status is required including school attendance during summer session.
c. Only engineering or technical majors will be authorized. The major will be approved by the Chief of Naval Operations (CNO) (N133).
d. A semester/quarter grade point average (GPA) of less than 3.0 on a 4.0 scale may result in academic probation and/or disenrollment.
e. Grades will be submitted to CNO (N133) immediately following each semester/quarter or work.
f. CNO (N133) may recommend disenrollment for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.)
g. If disenrolled for any reason, I will not be allowed to remain in STA-21.
h. If not accepted into the Naval Nuclear Propulsion Program as an officer when interviewed by the Director, Naval Nuclear Propulsion, I will be allowed to complete my degree and be commissioned as a non-nuclear unrestricted line officer.
i. Applications will be restricted to the following Universities: Auburn University. University of Arizona University of Idaho University of Utah University of Kansas University of New Mexico University of Washington University of Texas North Carolina State University Oregon State University Pennsylvania State University University of Illinois University of South Carolina University of Wisconsin State University of New York Maritime The Citadel Purdue and Southern University
j. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
k. If disenrolled, I will be screened per MILPERSMAN 1510-030 or OPNAVINST 1220.1D, as applicable, for return to the Nuclear Propulsion Program in an enlisted status. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I have completed 5 years of active enlisted service following the date I am disenrolled from the program.
l. An enlistment of 6 years upon receipt of orders to STA-21 is required.
m. A 5-year active duty obligation upon commissioning is incurred as a nuclear power officer.
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OPNAVINST 1420.1B 14 DEC 09
Section 9 to Chapter 8 of Enclosure (1) 8-57 n. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees and books.
o. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
p. For sea returnee NWPTC and NPTC staff members selected for this program: Assignment to the submarine or surface warfare communities upon commissioning will be based on the needs of the Navy. This may be predesignated and not necessarily consistent with previous experience (e.g. previously enlisted submarine qualified applicants may be assigned a surface warfare designator (1160) vice submarine designator (1170) and vice versa).
q. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 172
OPNAVINST 1420.1B 14 DEC 09
Section 10 to Chapter 8 of Enclosure (1)
8-58 SECTION 10 STATEMENT OF UNDERSTANDING – CIVIL ENGINEER CORPS (CEC) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 173
OPNAVINST 1420.1B 14 DEC 09
Section 10 to Chapter 8 of Enclosure (1)
8-59 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (CEC OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral-21 Commissioning Program (STA-21) as a Civil Engineer Corp Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Only NAAB-accredited architecture program or ABET-accredited engineering majors will be authorized. Preferred engineering degrees are civil, mechanical, and electrical engineering.
d. Complete 2 semester/3 quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
e. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
f. A semester/quarter grade point average (GPA) of less than 3.0 on a 4.0 scale may result in academic probation and/or disenrollment.
g. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
h. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
i. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees, and books.
j. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
k. An enlistment of 6 years upon receipt of orders to STA-21 is required.
l. A 5-year active duty obligation upon commissioning is incurred as a Civil Engineer Corp Officer.
m. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 174
OPNAVINST 1420.1B 14 DEC 09
Section 11 to Chapter 8 of Enclosure (1)
8-60 SECTION 11 STATEMENT OF UNDERSTANDING - PILOT OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 175
OPNAVINST 1420.1B 14 DEC 09
Section 11 to Chapter 8 of Enclosure (1)
8-61 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (PILOT OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 Commissioning Program (STA-21) as a Pilot Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Achieve a score of at least 4 on the Academic Qualification Rating (AQR), 5 on the Pilot Flight Aptitude Rating (PFAR) of the ASTB prior to acceptance into the STA-21 Pilot Option.
d. Complete 2 semester/3 quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
e. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
f. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
g. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
h. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
i. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees, and books.
j. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
k. An enlistment of 6 years upon receipt of orders to STA-21 is required.
l. Upon graduation from my assigned university, I will be commissioned as a Student Naval Aviator (SNA) and be ordered to the Aviation Pre-Flight Indoctrination (API) Course, Naval Aviation Schools Command, Pensacola, Florida.
m. An 8-year active duty obligation upon commissioning is incurred as a Naval Aviator or 6 years from date of disenrollment from flight training unless released by the Deputy Chief of Naval Operations (Manpower, Personnel, Training and Education) (DCNO (MPT&E)) (N1).
n. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant
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OPNAVINST 1420.1B 14 DEC 09
Section 11 to Chapter 8 of Enclosure (1)
8-62 Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 177
OPNAVINST 1420.1B 14 DEC 09
Section 12 to Chapter 8 of Enclosure (1)
8-63 SECTION 12 STATEMENT OF UNDERSTANDING - NAVAL FLIGHT OFFICER (NFO) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 178
OPNAVINST 1420.1B 14 DEC 09
Section 12 to Chapter 8 of Enclosure (1)
8-64 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (NFO OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 Commissioning Program (STA-21) as a Naval Flight Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Achieve a score of at least 4 on the Academic Qualification Rating (AQR), 5 on the Naval Flight Officer Flight Aptitude Rating (FOFAR) of the ASTB prior to acceptance into the STA-21 Naval Flight Officer Option.
d. Complete 2 semester/3 quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
e. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
f. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
g. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
h. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
i. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees, and books.
j. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
k. An enlistment of 6 years upon receipt of orders to STA-21 is required.
l. Upon graduation from my assigned university, I will be commissioned as a Student Naval Flight Officer (SNFO) and be ordered to the Aviation Pre-Flight Indoctrination (API) Course, Naval Aviation Schools Command, Pensacola, Florida.
m. A 6-year active duty obligation upon commissioning is incurred as a Naval Aviator or 6 years from date of disenrollment from flight training unless released by the Deputy Chief of Naval Operations (Manpower, Personnel, Training and Education) (DCNO (MPT&E)) (N1).
n. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant
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OPNAVINST 1420.1B 14 DEC 09
Section 12 to Chapter 8 of Enclosure (1)
8-65 Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 180
OPNAVINST 1420.1B 14 DEC 09
Section 13 to Chapter 8 of Enclosure (1)
8-66 SECTION 13 STATEMENT OF UNDERSTANDING - EXPLOSIVE ORDNANCE DISPOSAL (EOD) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 181
OPNAVINST 1420.1B 14 DEC 09
Section 13 to Chapter 8 of Enclosure (1)
8-67 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (EOD OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 Commissioning Program (STA-21) as an Explosive Ordnance Disposal Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Complete 2 semester/3 quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
d. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
e. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
f. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
g. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
h. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees, and books.
i. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
j. An enlistment of 6 years upon receipt of orders to STA-21 is required.
k. A 5-year active duty obligation upon commissioning.
l. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 182
OPNAVINST 1420.1B 14 DEC 09
Section 14 to Chapter 8 of Enclosure (1)
8-68 SECTION 14 STATEMENT OF UNDERSTANDING - SPECIAL WARFARE (SPECWAR) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 183
OPNAVINST 1420.1B 14 DEC 09
Section 14 to Chapter 8 of Enclosure (1)
8-69 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (SPECWAR OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 Commissioning Program (STA-21) as a Special Warfare Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Complete 2 semester/3 quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
d. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
e. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
f. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
g. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.)
h. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees, and books.
i. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
j. An enlistment of 6 years upon receipt of orders to STA-21 is required.
k. A 5-year active duty obligation upon commissioning.
l. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 184
OPNAVINST 1420.1B 14 DEC 09
Section 15 to Chapter 8 of Enclosure (1)
8-70 SECTION 15 STATEMENT OF UNDERSTANDING - NURSE CORPS (NC) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 185
OPNAVINST 1420.1B 14 DEC 09
Section 15 to Chapter 8 of Enclosure (1)
8-71 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (NC OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 Commissioning Program (STA-21) as a Nurse Corps Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree in Nursing must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Entry into nursing school is highly competitive. Nurse Option selects, should be aware of the competitive (not qualifying) criteria for the School of Nursing to which they apply. Failure to be accepted into the School of Nursing will result in disenrollment from the STA-21 program. Degree plans must be reviewed and signed by faculty from the School of Nursing and NROTC unit staff.
d. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
e. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
f. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
g. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
h. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees, and books.
i. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
j. An enlistment of 6 years upon receipt of orders to STA-21 is required.
k. A 5-year active duty obligation upon commissioning.
l. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 186
OPNAVINST 1420.1B 14 DEC 09
Section 16 to Chapter 8 of Enclosure (1) 8-72 SECTION 16 STATEMENT OF UNDERSTANDING - SURFACE WARFARE OFFICER (SWO) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been merged in the military personnel record are destroyed after 2 years. ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 187
OPNAVINST 1420.1B 14 DEC 09
Section 16 to Chapter 8 of Enclosure (1) 8-73 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (SWO OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 Commissioning Program (STA-21) as a Surface Warfare Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Complete 2 semester/3 quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
d. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
e. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
f. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
g. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.)
h. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees, and books.
i. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
j. An enlistment of 6 years upon receipt of orders to STA-21 is required.
k. A 5-year active duty obligation upon commissioning.
l. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 188
OPNAVINST 1420.1B 14 DEC 09
Section 17 to Chapter 8 of Enclosure (1)
8-74 SECTION 17 STATEMENT OF UNDERSTANDING - SUPPLY CORPS (SC) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 189
OPNAVINST 1420.1B 14 DEC 09
Section 17 to Chapter 8 of Enclosure (1)
8-75 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (SUPPLY OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 Commissioning Program (STA-21) as a Supply Corps Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree in business, engineering, or math–related fields must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Complete 2 semester/3 quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
d. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
e. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
f. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
g. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
h. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees, and books.
i. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
j. An enlistment of 6 years upon receipt of orders to STA-21 is required.
k. A 5-year active duty obligation upon commissioning.
l. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 190
OPNAVINST 1420.1B 14 DEC 09
Section 18 to Chapter 8 of Enclosure (1)
8-76 SECTION 18 STATEMENT OF UNDERSTANDING - SPECIAL DUTY OFFICER INTELLIGENCE (Intel) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 504,505, 507,532, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel have access to client data. RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been merged in the military personnel record are destroyed after 2 years. ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 191
OPNAVINST 1420.1B 14 DEC 09
Section 18 to Chapter 8 of Enclosure (1)
8-77 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (INTEL OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 Commissioning Program (STA-21) as a Special Duty (Intelligence) Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Complete 2 semester/3 quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
d. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
e. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
f. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
g. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
h. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees and books.
i. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
j. An enlistment of 6 years upon receipt of orders to STA-21 is required.
k. A 5-year active duty obligation upon commissioning.
l. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 192
OPNAVINST 1420.1B 14 DEC 09
Section 19 to Chapter 8 of Enclosure (1) 8-78 SECTION 19 STATEMENT OF UNDERSTANDING - SPECIAL DUTY OFFICER INFORMATION WARFARE (IW) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 504,505, 507,532, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel have access to client data. RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been merged in the military personnel record are destroyed after 2 years. ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 193
OPNAVINST 1420.1B 14 DEC 09
Section 19 to Chapter 8 of Enclosure (1) 8-79 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (INFORMATION WARFARE OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 Commissioning Program (STA-21) as a Special Duty (Information Warfare) Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Complete 2 semester/3 quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
d. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
e. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
f. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
g. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
h. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees, and books.
i. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
j. An enlistment of 6 years upon receipt of orders to STA-21 is required.
k. A 5-year active duty obligation upon commissioning.
l. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 194
OPNAVINST 1420.1B 14 DEC 09
Section 20 to Chapter 8 of Enclosure (1) 8-80 SECTION 20 STATEMENT OF UNDERSTANDING - CORE OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces . The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 195
OPNAVINST 1420.1B 14 DEC 09
Section 20 to Chapter 8 of Enclosure (1) 8-81 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (CORE OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 Commissioning Program (STA-21) as a Core Option Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Complete 2 semester/3 quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
d. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
e. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
f. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
g. I may be disenrollment for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
h. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees, and books.
i. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
j. An enlistment of 6 years upon receipt of orders to STA-21 is required.
k. To be considered for the Nuclear option must meet/adhere with the requirements of section 9.
l. To be considered for the Pilot option must meet/adhere with the requirements of section 11.
m. To be considered for the NFO option must meet/adhere with the requirements of section 12.
n. To be considered for the EOD option must meet/adhere with the requirements of section 13.
o. To be considered for the SPECWAR option must meet/adhere with the requirements of section 14.
p. To be considered for the SWO option must meet/adhere with the requirements of section 16.
p. 196
OPNAVINST 1420.1B 14 DEC 09
Section 20 to Chapter 8 of Enclosure (1) 8-82 q. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 197
OPNAVINST 1420.1B 14 DEC 09
Section 21 to Chapter 8 of Enclosure (1) 8-83 SECTION 21 STATEMENT OF UNDERSTANDING - MEDICAL CORPS (MC) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 198
OPNAVINST 1420.1B 14 DEC 09
Section 21 to Chapter 8 of Enclosure (1) 8-84 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM (MC OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 Commissioning Program (STA-21) as a Medical Corps Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree with a pre-medical concentration must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
d. A semester/quarter grade point average (GPA) of less than 3.0 on a 4.0 scale may result in academic probation and/or disenrollment.
e. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
f. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
g. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees, and books.
h. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
i. An enlistment of 6 years upon receipt of orders to STA-21 is required.
j. A 5-year active duty obligation upon commissioning.
k. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 199
OPNAVINST 1420.1B 14 DEC 09
Section 22 to Chapter 8 of Enclosure (1) 8-85 SECTION 22 STATEMENT OF UNDERSTANDING - SWO (INFORMATION PROFESSIONAL (IP)) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202, 4346, 2122, 12209, 12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 200
OPNAVINST 1420.1B 14 DEC 09
Section 22 to Chapter 8 of Enclosure (1) 8-86 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL – 21 PROGRAM SWO (IP OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral- 21 Commissioning Program (STA-21) as a Surface Warfare (IP Option) Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree with a pre-medical concentration must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will I be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
d. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
e. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the data I am disenrolled from the program.
f. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
g. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees, and books.
h. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
i. An enlistment of 6 years upon receipt of orders to STA-21 is required.
j. A 5-year active duty obligation upon commissioning.
k. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.1H and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 201
OPNAVINST 1420.1B 14 DEC 09
Section 23 to Chapter 8 of Enclosure (1) 8-87 SECTION 23 STATEMENT OF UNDERSTANDING - SWO (ENGINEERING DUTY (ED)) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978,1201, 1202,4346,2122,12209,12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system.
DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 202
OPNAVINST 1420.1B 14 DEC 09
Section 23 to Chapter 8 of Enclosure (1) 8-88 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STA I am volunteering for the Seaman to Admiral-21 Commissioning Program (STA-21) as a Surface Warfare (Engineering Duty Option) Officer Candidate. TEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL-21 PROGRAM (SWO ENGINEERING DUTY OPTION) REQUIREMENTS If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Complete two semester/three quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
d. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
e. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
f. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the date I am disenrolled from the program.
g. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
h. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees and books.
i. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
j. An enlistment of 6 year upon receipt of orders to STA-21 is required.
k. A 5-year active duty obligation upon commissioning.
l. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.l series and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
p. 203
OPNAVINST 1420.1B 14 DEC 09
Section 24 to Chapter 8 of Enclosure (1) 8-89 SECTION 24 STATEMENT OF UNDERSTANDING - SWO (OCEANOGRAPHY (OCEANO)) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552, 978, 1201, 1202,4346,2122,12209,12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system.
DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
p. 204
OPNAVINST 1420.1B 14 DEC 09
Section 24 to Chapter 8 of Enclosure (1) 8-90 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL-21 PROGRAM SWO OCEANO OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral-21 Commissioning Program (STA-21) as a Surface Warfare (OCEANO Option) Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Complete two semester/three quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
d. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
e. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
f. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the date I am disenrolled from the program.
g. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
h. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees and books.
i. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
j. An enlistment of 6 years upon receipt of orders to STA-21 is required.
k. A 5-year active duty obligation upon commissioning.
l. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.l series and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
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OPNAVINST 1420.1B 14 DEC 09
Section 25 to Chapter 8 of Enclosure (1) 8-91 SECTION 25 STATEMENT OF UNDERSTANDING - HUMAN RESOURCE (HR) OPTION
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 552,978,1201, 1202,4346,2122,12209,12241; E.O. 9397. 504,505, 507,532, PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1,Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel s to client data. have acces RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been military personnel record are destroyed after 2 years. merged in the ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system.
DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.
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OPNAVINST 1420.1B 14 DEC 09
Section 25 to Chapter 8 of Enclosure (1) 8-92 FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE (THIS PAGE IS UNCLASSIFIED BUT MARKED “FOUO” FOR SAMPLE PURPOSES ONLY)
ADMINISTRATIVE REMARKS NAVPERS 1070/613
Ship or Station
STATEMENT OF UNDERSTANDING OF SEAMAN TO ADMIRAL-21 PROGRAM (HUMAN RESOURCE OPTION) REQUIREMENTS I am volunteering for the Seaman to Admiral-21 Commissioning Program (STA-21) as a (Human Resource Option) Officer Candidate. If accepted, I understand that the following requirements apply:
a. Requirements for a Baccalaureate degree must be completed in 36 months or less.
b. Full time student status is required including school attendance during summer session.
c. Complete two semester/three quarters of calculus and calculus-based physics receiving a passing grade of “C” or better.
d. I will receive full pay and allowances for my enlisted pay grade and up to $10,000 per year, paid to the university by the Naval Service Training Command to supplement costs of tuition, books and other fees incurred. I understand that I will not be eligible for tuition assistance under the Navy’s Tuition Assistance Program, nor will be eligible to use any Montgomery GI Bill (MGIB) or Veteran’s Educational Assistance Program (VEAP) educational benefits for current expenses while enrolled in the STA-21 program.
e. A semester/quarter grade point average (GPA) of less than 2.5 on a 4.0 scale may result in academic probation and/or disenrollment.
f. If disenrolled for any reason, I will not be allowed to remain in STA-21 and may be processed for separation or returned to the fleet for completion of obligated service. If deemed unsuitable for active duty, I may be subject to recoupment of all tuition, fees, and books. This obligation remains until I complete 5 years active enlisted service following the date I am disenrolled from the program.
g. I may be disenrolled for academic reasons or discipline/moral problems (drug usage, civil convictions, etc.).
h. STA-21 students who drop on request prior to commissioning will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of their enlistment contract, whichever is longer. They will also be subject to recoupment of all tuition, fees and books.
i. STA-21 disenrollees who complete degree requirements, but fail to be commissioned, will incur a 5-year enlisted service obligation from the date of program disenrollment.
j. An enlistment of 6 year upon receipt of orders to STA-21 is required.
k. A 5-year active duty obligation upon commissioning.
l. I currently meet the Navy’s physical fitness and height, weight and body fat standards of OPNAVINST 6110.l series and understand that I am required to remain within these requirements (must maintain a good low for the duration of the program).
_______________________________ __________________________________ Signature/Date of Witnessing Officer Signature/date of Applicant Name (Last, First, Middle) Last 4 of SSN Branch and Class
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OPNAVINST 1420.1B 14 DEC 09
Appendix A to Enclosure (1) A-1 APPENDIX A USNA APPLICANT CHECKLIST AND SUPPORTING DOCUMENTS
CHECKLIST FOR U.S. NAVAL ACADEMY (USNA) APPLICANTS
1. Preliminary application completed (via the following Web address: www.usna.edu/Admissions/pre-application). Be sure to indicate that you are Active Duty or Reserve, and Rate/Rank. High School name should be entered as FLEET, with the following high school ETS code: 999998.
2. Application request for a SECNAV nomination submitted via the chain of command following the sample provided on appendix A-2 through A-3.
3. Commanding Officer’s Endorsement/Recommendation following the sample provided on appendix A-4. Attached to candidate’s SECNAV application request. Original and one copy forwarded to Admissions Office, USNA.
4. All High School and College Transcript(s) ordered and sent to Admissions Office, USNA.
5. Official SAT/ACT scores ordered and sent to Admissions Office, USNA. SAT and/or ACT re-taken if scores are over 2 years old.
6. Candidate packet received from USNA completed and returned as soon as possible. All documents are required to be completed. (Do not send any of the documents back to your high school for "official" signature.) These documents should be verified and signed by your command career counselor, or a commissioned officer in your chain of command.
7. After receiving your candidate number and candidate packet, make contact with the DoD Medical Examination Review Board (DODMERB), and schedule an appointment. You can reach them through their scheduling number at 1-800-841-2706.
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OPNAVINST 1420.1B 14 DEC 09 Appendix A to Enclosure (1) A-2
SAMPLE FORMAT FOR LETTER OF APPLICATION (Submit original and one copy)
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on the forms referenced in this instruction. Please read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. Section § 32, 504,505, 507,532, 552, 978, 1201, 1202, 4346, 2122, 9397. 12209, 12241; E.O. PRINCIPAL PURPOSES: Information collected by this form will be used to determine applicant's qualifications for commission in the U.S. Navy and programs leading to commission. The authority governing this collection is Privacy Act Systems of Record Notice N01070-3, Navy Military Personnel Records System; N01420-1, Enlisted to Officer Commissioning Programs; NM06150-6, Medical Readiness Reporting System (MRRS). These notices can be downloaded at http://privacy.navy.mil/privacy/noticenumber/ . SAFEGUARDS: Password controlled system, file, and element access based on predefined need-to-know. Physical access to terminals, terminal rooms, buildings and activities' grounds are controlled by locked terminals and rooms, guards, personnel screening and visitor registers. Password complexity, expiration, minimum length, and history will assist in assuring only appropriate personnel have access to client data. RETENTION: The collected information provided is FOR OFFICIAL USE ONLY and may become a permanent part of your service record. Records which have not been merged in the military personnel record are destroyed . after 2 years ROUTINE USES: To obtain background and medical information from the application to determine applicant’s qualifications and medical fitness for commission and programs leading to commission, appointment and retention in the Armed Forces. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of system of record notices apply to this system. DISCLOSURE: Providing information on this form is voluntary. However, failure to provide the requested information as well as the Social Security Number may result in denial of appointment into the United States Navy. If after you are appointed, it is found that you concealed a record, you may be discharged from the U.S. Navy as a fraudulent appointment and may be subject to a fine and/or imprisonment. All collected personal data will be safeguarded pursuant to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or the personal privacy exemptions of the Freedom of Information Act [5 U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.